III. Selected Strategic Priorities and Analyses

Critical interventions work to combat HIV/AIDS, tuberculosis, malaria, avian and pandemic influenza, neglected tropical diseases, polio, pneumonia, and diarrhea. Within these program areas, mothers and children are two special target groups. In addition, U.S. assistance works to strengthen local capacity to detect and respond to disease outbreaks; improve delivery of health services, essential drugs, and commodities; and support advances in health technology. The Global Health Initiative (GHI) which the President announced in May 2009, seeks to improve outcomes across these elements by adopting a women- and girl-centered approach, increasing strategic integration and coordination within the U.S. Government and with partner countries, strengthening and leveraging multilateral institutions, encouraging country ownership, enhancing sustainability by strengthening healthy systems, improving metrics and evaluation, and promoting research and innovation.

HIV/AIDS Analysis: The bulk of U.S. HIV/AIDS funding is provided through the President’s Emergency Plan for AIDS Relief (PEPFAR), which takes a comprehensive approach to HIV/AIDS prevention, treatment, and care in developing countries. This program works in close cooperation with host country governments and national and international partners. The indicator on the number of people receiving HIV/AIDS treatment measures the reach of PEPFAR and highlights which countries are facing challenges in scaling up their programs and which may have best practices that should be replicated elsewhere. PEPFAR-supported treatment has helped to save and or extend millions of lives as well as avoid the orphaning of hundreds of thousands of children whose parents have HIV/AIDS. Because of the rapid scale-up of the programs, the United States directly supported treatment for some 2.4 million people living with HIV in FY 2009, exceeding the target by over 200,000. Targets for FY 2010 and FY 2011 will be available in mid- to late 2010, following the headquarters review of Country Operational Plans.

Tuberculosis Analysis: Twenty-two developing countries account for 80% of the world’s tuberculosis (TB) cases; the disease kills more than 1.1 million people each year in those countries. Furthermore, TB is a serious and common co-infection for HIV-infected individuals. The focus of USAID’s TB program is to combat multi-drug-resistant TB and extremely drug-resistant TB, and to prevent drug resistance by improving the quality of basic TB services.

One of the performance indicators for TB is the tuberculosis treatment success rate (TBS), or the proportion of patients who complete their entire course of treatment. Because TB is transmitted in the air when an infected person coughs or sneezes, effective treatment of persons with the disease is critical to interrupting the transmission of TB. Tracking progress toward meeting or exceeding the TBS target of 85% is a key indicator as to how effectively the United States is fighting this disease. TBS has improved steadily in high-burden countries in Africa, Asia, and the Middle East, and several countries receiving U.S. support have met or exceeded the threshold for this indicator. The United States exceeded its FY 2009 target because the impact of a $70 million FY 2008 funding increase for USAID led to the scaling up of TB activities in priority countries. Progress will be slower in countries like Russia due to high rates of HIV infection, drug resistance, and inadequate health services.

Malaria Analysis: In June 2005, the President’s Malaria Initiative (PMI) was launched, pledging to increase U.S. funding by more than $1.2 billion over five years to reduce deaths from malaria by 50% in 15 African countries. The increased funding enables the United States to accelerate expansion of the malaria initiative program to achieve the target. The two critical emphases of the malaria initiative are insecticide-treated mosquito nets (ITN) and indoor residual spraying (IRS), which when used properly are highly effective in controlling malaria. These prevention measures are expected to contribute to lower prevalence of malaria in countries and, as a consequence, reductions in morbidity and mortality, especially among pregnant women and children.

The number of people protected against malaria with a prevention measure (ITN, IRS, or both) supported by PMI funds is an indicator of U.S. progress in extending the prevention measures that are necessary to reduce the number of malaria deaths in 15 African countries by 50%. In FY 2009, the United States exceeded its target because PMI is now a more mature program that has strong national commitment from the host country and other donors. With this support, PMI has been able to implement its program more effectively.

Maternal and Child Health Analysis: This program aims to increase the availability and use of proven life-saving interventions that address the major killers of mothers and children. These interventions include effective maternal and newborn care, management of obstetric complications, routine immunization, polio eradication, micronutrients, and improved maternal, infant, and young child feeding. Maternal and child health is also a core component of the GHI.

Increasing the frequency of deliveries overseen by skilled birth attendants is more likely to result in prompt recognition of complications, initiation of treatment, and lives saved. The use of skilled birth attendants has increased considerably, more than doubling over the past decade in Nepal, Indonesia, Bangladesh, and Egypt. An increase in the coverage of attended births is expected to contribute to lower maternal and child morbidity and mortality. In FY 2009, U.S. assistance programs exceeded their target and continued a trend of steady improvement in the percent of live births attended by skilled birth attendants.

Family Planning and Reproductive Health Analysis: The United States’ family planning and reproductive health (FP/RH) program aims to expand access to high-quality, voluntary family planning and reproductive health information and services, in order to reduce unintended pregnancies and promote healthy reproductive behaviors. Increased use of modern contraception, one of three main indicators for this area, translates into fewer unintended pregnancies and fewer abortions. A strong family planning program can be expected to increase the modern contraceptive prevalence rate (MCPR) at the country level by one to two percentage points annually. The MCPR indicator measures the percentage of in-union women of reproductive age (15-49) using, or whose partner is using, a modern method of contraception at the time of the survey. In FY 2009, U.S. programs contributed to nearly a percentage point increase in MCPR in assisted countries, but fell very slightly short of the target.

Water Supply and Sanitation Analysis: Access to a reliable and economically sustainable water supply is a key component of a country’s ability to attain health, security and prosperity for its population. Access is achieved through diverse approaches, including both direct support for small and large-scale infrastructure development and indirect support through institutional development, community-based systems, facilitation of private supply of products and services, and financing to ensure long-term sustainability and expansion of access.

The United States tracks the number of new people who gain access to an improved water source in the reporting period, such as a household connection, public standpipe, borehole, protected well or spring, or rainwater collection as a result of U.S. assistance. The overall target for FY 2009 was greatly exceeded due in part to momentum gained from a new regional program in Asia. In South Africa, a greater than anticipated number of water projects were approved by the local government, and Haiti reached more beneficiaries due to the additional resources from the 2008 hurricane recovery funds.

EDUCATION:Promote the creation and maintenance of effective, equitable, high-quality educational services and systems, from the primary education and literacy program level to strengthening the institutional capacities of public and private higher educational institutions.

USAID supports social and economic transformation and reconciliation for vulnerable rural women in Rwanda. World Relief Rwanda and Ikirezi Image

Analysis: In the basic education sector, the United States assesses its performance based on the primary net enrollment rate (NER) for a sample of countries receiving basic education funds. Although USAID is certainly not solely responsible for supporting increases in enrollment rates, there is plausible attribution to the U.S. Government for this meaningful performance indicator. Since 2002, NER have steadily improved in countries receiving U.S. assistance. This trend is expected to continue with additional funding to help ministries of education establish and maintain more effective school systems, provide teacher training, develop and conduct learning assessments, and collect and use data to assist with school management decisions, particularly those related to enrollment and the learning environment. The rate of increase will be slower as countries approach 100% enrollment, with the remaining population the most difficult and expensive to reach. In FY 2009, the United States met its target of 79% NER.

Climate Change

The world community must work collaboratively to slow, stop, and reverse greenhouse gas emissions in a way that promotes sustainable economic growth, increases energy security, and helps nations deliver greater prosperity for their people. The U.S. Government addressed this challenge during FY 2009 through a whole-of-government approach that combines actions from reducing U.S. emissions at home, to developing transformational low-carbon technologies, to improving observation systems that will help the USG better understand and address the impacts of climate. Within the U.S. Government, the State Department led the effort to reach a global climate change accord at Copenhagen in December 2009 that captures President Obama’s vision, working closely with other large emitters such as the EU, China, Russia, and India in the Major Economies Forum on Energy and Climate. USAID led bilateral assistance efforts that promote cleaner and renewable energy technologies, energy and building efficiency, protection of forests that serve as carbon “sinks,” and assistance to build the resilience of nations and communities that are highly vulnerable to climate change. As the international community moves to implement the Copenhagen Accord, the United States will do its part by meeting the commitment to reduce emissions at home and to provide increased financial resources for developing countries, particularly those most vulnerable to climate change and with the least capacity to respond. For further information on climate change, visit Climate and Environment.

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